Lung issues that take Malaysian breathes away

The next time you sneeze, you might want to do a “DAB”. That’s to cover your mouth. With swag. Just ask a teenager and they might show you how to “dab”, a popular African American dance move. A school principal in Ohio was inspired to create the DAB poster with his clever message “Destroy All Bacteria. DAB when you sneeze” to educate his students about public hygiene. His same message might just help Malaysians stop the spread of pneumonia and tuberculosis in Malaysia, among the two top respiratory illnesses in the country.

In 2015, diseases of the respiratory system were the second principal cause of death in Ministry of Health hospitals. It also ranked as the second cause of hospitalisation in both Ministry of Health and private hospitals in Malaysia in that same year.

According to the Ministry of Health’s 2016 data, tuberculosis also recorded a high incidence rate (79.45 out of a 100,000 population) among all the communicable diseases and has a leading mortality rate (5.5 out of a 100,000 population).

Pneumonia: When lungs “drown”

Pneumonia was also the leading cause of death for Malaysian women and the second principal cause of death in Malaysian men in 2014.

It was reported in the Star in February this year that a superbug named ‘Klebsiella pneumoniae’ was responsible for the deaths from pneumonia in Malaysia recently.

Commonly, the Streptococcus pneumoniae (S. pneumonia) is the bacteria behind pneumonia while there are other strains like the Haemophilus influenza and Staphylococcus aureus.

The research also pointed out that one of the possible causes for pneumonia deaths in Malaysia could be the over-prescription of antibiotics which leads to a higher resistance towards the bacteria behind pneumonia.

In February this year, the Star reported that a superbug named ‘Klebsiella pneumoniae’ was responsible for pneumonia deaths in Kelantan. Earlier in January, the CDC reported that a 70-year-old woman from Nevada had died in September after developing a bacterial infection that was resistant to 26 types of antibiotics, also due to the Klebsiella pneumoniae strain.

The Malaysian analysis also suggested that there may be a possible link between pneumonia infections and the increase in tuberculosis incidents locally.

The symptoms of pneumonia are similar to the common flu. Symptoms include difficulties in breathing with shortness of breath during daily physical activities like climbing stairs, chills accompanied by shaking, high fever and a long spell of persistent coughs (with thick, yellowish mucus). These are early warning signs of pneumonia which will be treated with antibiotics.

Lung cancer – the lead killer

Although lung cancer isn’t as common as other forms of cancer, yet, it is the lead killer among cancer deaths in Malaysia. According to Dr. Helmy Haja Mydin, consultant respiratory physician at Pantai Hospital Kuala Lumpur, this is because patients tend to discover lung cancers at stages 3 and 4, by which time is too late.

To help diagnosis and detection, he advises that if a cough persists for more than three weeks, people should go see a GP.

For male lung cancer patients, 80% are smokers. The numbers do not surprise us because 43% of Malaysian men are smokers while only 1.4% to 1.6% of women smoke, with an estimated total of five million smokers in the country, according to the National Health and Morbidity Survey 2015.

Secondhand and never-smokers at risk

The NHM survey also showed 40% of adults (7.6 million) are exposed to secondhand smoke inside their houses, 40% (2.3 million) at their workplaces, and 70% of adults (8.6 million) at public places like restaurants. “Even if you smoke outside and come in smelling of smoke on your clothes, that smelly odour is actually the chemicals in your cigarette,” Dr. Helmy said.

There is also an increase in the incidence of non-smoking Asian women getting lung cancer. According to a study conducted by the National Cancer Centre Singapore, three out of 10 cancer patients they’d studied were never-smokers. Out of the population of never-smokers who had lung cancer, 70% are women. A woman’s exposure to smoke at the workplace or home will increase her chance of lung cancer by 25%.

Dr. Helmy said there is a study that shows 60% of smokers want to quit. “Quitting is hard. Most people quit because of a particular reason, and sometimes they quit not because of themselves, but because of other people. Like dads quitting when their wives get pregnant because they don’t want their child to grow up in an environment of smoke.”

Concerns about E-cigarettes

The conversation about cancer and quitting smoking naturally led to the topic of e-cigarettes, or vapes. Dr. Helmy shared his thoughts about e-cigarettes. “At the moment, there’s no evidence for it. And what you do find is that some people end up as dual smokers. They smoke e-cigarettes but once in a while, there’s not enough battery, or you didn’t get enough ‘vape juice’, so you just take one cigarette.”

He also said quitting involves steps leading to cessation of smoking, but he hasn’t seen evidence of people stopping. “Most people don’t stop. They just continue indefinitely on e-cigarettes, so in a sense it’s not doing its job as a quitting tool,” he said. Another concern is the lack of quality control of the ‘vape juices’. Not enough long term studies have been carried out to come to come to concrete conclusions yet.

In a Cancer Research UK funded research involving 181 participants[1], the first of its kind study looking at long term vaping effects, it was found that smokers who use only e-cigarettes had a substantially lower level of cancer causing chemicals, tobacco specific nitrosamines (TSNAs) and volatile chemical compounds (VOCs) found in their body. E-cigarette smokers may light up more with this news but Dr. Helmy cautioned that the nicotine in them is still addictive.

The study does seem to suggest a reduced exposure to toxic chemicals that could cause cancer in smokers, but the report from NHS choices cautioned that this is provided that e-cigarette smokers cease from smoking combustible cigarettes.

[1] “Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study”, accessed from http://annals.org/aim/article/2599869/nicotine-carcinogen-toxin-exposure-long-term-e-cigarette-nicotine-replacement

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